Evidence map›Paper›PMID 40371950›Full record

Trial reportHuman vaccines & immunotherapeutics2025

CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of implementation outcomes from a cluster randomized trial.

Anna Taddio, James Morrison, Charlotte Logeman, Victoria Gudzak, Lucie M Bucci, C Meghan McMurtry, Molly Yang, Mike Folinas, Rahim Moineddin, Noni E MacDonald

Abstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Human vaccines & immunotherapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Reducing distress during vaccine injections: 2026 clinical practice guideline update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Guideline
  2. Pooled it
  3. Trial
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  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Anna TaddioLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.ORCID 0000-0003-4432-8975
James MorrisonPharmacy Excellence, Wholehealth Pharmacy Partners, Markham, ON, Canada.
Charlotte LogemanClinical Research Coordinator, The Hospital for Sick Children, Toronto, Canada.
Victoria GudzakLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Lucie M BucciPublic Health Consultant, Bucci-Hepworth Health Services Inc, Pincourt, Canada.
C Meghan McMurtryDepartment of Psychology, University of Guelph, Guelph, Canada.
Molly YangPharmacy Innovation & Professional Affairs, Wholehealth Pharmacy Partners, Markham, ON, Canada.
Mike FolinasLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Rahim MoineddinFaculty of Medicine, University of Toronto, Toronto, Canada.
Noni E MacDonaldFaculty of Medicine, Dalhousie University, Halifax, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The CARD system (Comfort Ask Relax Distract) is a protocol for vaccine delivery that includes interventions that facilitate vaccine recipient coping and improve the vaccination experience. CARD was compared to control (usual care) in a pragmatic hybrid effectiveness-implementation cluster randomized trial. Of 25 participating community pharmacies, 12 were randomized to CARD and 13 to control for all vaccines administered between November 2023 and January 2024. Implementation strategies planned to support CARD integration included an educational webinar, customized implementation recommendations, change equipment, online chat group, and audit and feedback. Educational outreach was added to improve intervention fidelity. This paper reports on implementation outcomes of the trial. Provider surveys and focus groups revealed acceptability and feasibility of CARD and implementation strategies. Vaccinators in CARD pharmacies (vs. control) reported higher satisfaction with vaccine recipient interactions and that overall, CARD was time neutral. They also reported higher utilization of some CARD-recommended injection techniques. Administrative data verified utilization of the CARD coping checklist, which solicits vaccine recipient coping preferences, in 96% of vaccine recipients that participated. Post-vaccination feedback surveys were available for 90% of vaccine recipients that participated. Implementation results were aligned with trial effectiveness outcomes, and support routine use of CARD in community pharmacies.

Indexed as

Community Pharmacy ServicesVaccinationVaccinesAdultFemaleHumansMaleMiddle AgedPharmaciesSurveys and QuestionnairesVaccinesimplementation sciencepain managementPharmacythe CARD systemvaccinationvaccination services

Identifiers

PMID40371950
PMCPMC12087484

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.